Hamdard Medicus

Vol. 55, No. 3, 2012

Temperament of Drugs in Unani Medicine A Critical Analysis

Mohammad Tarique Ahsan and Sharique Zafar Department of Ilmul Advia, Dr. M.I.J.T. Unani Medical College and H.A.R.K. Hospital, Versova, Andheri (W), Mumbai-400 061, India.

Introduction Mizaj (temperament) is one of the main basic fundamental principles of Ilmul-Advia (pharmacology) of Unani system of medicine. There exists a concept that all the three natural sources of drugs (mawaleed-e-salasa) possess four qualities in different proportions, i.e. hararat (heat), buroodat (cold), yaboosat (dryness) and rutoobat (moisture); and a new Mizaj is formed by their inter-action. The dominant property (kaifiyat-e-ghaliba) which finally prevails is called as Mizaj-e-advia constitution of the drug or temperament. The Mizaj of drug is thus expressed in term of four kaifiyat (qualities) i.e. har (hot), barid (cold), yabis (dry) and ratab (moist). These qualities signify particular meanings when attributed to drugs (Ahmad, 1980). Ibn Sina says that “whenever we say a thing to be har (hot) or barid (cold), we never mean that it is bi’l-fi’l (actually) hot or cold (i.e. it feels hot or cold on touching) but we actually mean that the thing is bi’l-quwa (potentially) hot or cold. And further we mean that it is potentially hot or cold in comparison to our body” (Ibn Sina, 1930). The quwwat (potency is developed inside the body), when is functionally affected by hararat ghariziyah (innate heat) of the body and has actually (bi’l-fi’l) developed in the body. The four qualities actually meant that when a drug is taken and is reacted with the Akhlat and Rutoobat (humours) and with hararat ghariziyah, i.e. with the biological systems, it produces certain signs and symptoms which are attributed to heat, cold, moistness or dryness (Ahmad, 1980). The concept of Mizaj-e-advia and its grading is based largely on the philosophical and logical evidences and to some extent on the experiences of Unani scholars. Many shortcomings are revealed on a thorough analysis of the Unani literature, as some scholars have reduced the concept of Mizaj to merely philosophical deductions and thereby indirectly affected the progress of the system. Here we would like to quote the views of a famous Unani scholar, Hakim Kabiruddin, from the preface of his book Tarjuma-e-Nafeesi, as he says – “but among the grading of the drugs, in spite of lot of difference in views, I have followed them totally, because I could not yet reach to any final conclusion. And in spite, that my doubts are not cleared yet; my inner sense has not come to the conclusion that there is no benefit of grading of drugs in our methodology of treatment” (Kabiruddin, 1924). Naturally occurring mufrad (single) drugs are composed of organic and inorganic ingredients having diverse qualities and functions. Some are active and more potent and some are less active and they sub-serve many functions. Sometimes an ingredient enhances the action of other ingredient; hence it performs synergistic action. While sometimes an ingredient counteracts the deleterious effect of another (potent) medicinally active ingredient and therefore, the toxic effects of the drug are minimized if taken as in a crude form and thus that ingredient acts as a Musleh (corrective). All different ingredients of a drug have different surat nau’yah (molecular structures) and therefore, their Mizaj (temperaments) are also different. When the compounds of different temperaments assemble together in a particular drug, there develops one resultant temperament in the natural compound (murakkab) which is the sumtotal of all the temperaments. The temperaments of active ingredients dominate and because of (the dominant) 73

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temperament, the properties of one drug differ from those of another. If there are more than one active ingredients (ajza’-e-fa’alah) of diverse properties and functions, the drug is known as Murakkab al-quwa (multi-potency drug) (Ahmad, 1980). Categories of Mizaj-e-Advia According to the dominance and different proportions of basic properties, the temperament of drugs is divided into nine categories. 1. 2. 3. 4. 5. 6. 7. 8. 9.

Mo’tadil (normal) Har mo’tadil (normal dominated by heat) Barid mo’tadil (normal dominated by cold) Yabis mo’tadil (normal dominated by dryness) Ratab mo’tadil (normal dominated by wetness) Har ratab (hot and moist) Har yabis (hot and dry) Barid ratab (cold and moist) Barid yabis (cold and dry)

Grades of Mizaj-e-Advia The categories of different temperaments of drugs are further assigned four darajat (grades), according to their severity of basic kaifiyaat (properties): 1.

Darjah awwal (first grade) The drugs of first grade are very mild in action and in low doses their effects are not felt externally and their heavy doses or prolong administration produce little change but do not disturb the body functions at all. Their effects remain confined up to the arwah-e-majari (vital force circulating in vessels) and does not go beyond that internally (Hakeem, 2002). 2.

Darjah doem (second grade) These drugs are moderate in action and their effects are felt after administration of the first (therapeutic) dose. In heavy doses or on prolong administration, they do not produce any adverse effect or disturbance. Their effects go beyond arwah-e-majari (vital force circulating in vessels) and remain (active) up to the akhlat (humours) of the body (Hakeem, 2002). 3. Darjah soem (third grade) The drugs of third grade are strong in action, their side effects are felt and seen after administration of their first dose. In heavy doses, even for a short duration use, they may produce sometimes severe adverse effects but are not fatal. From arwah-e-majari and akhlat their effect goes up to the rutoobat-e-saniyah (secondary fluids or metabolites) (Hakeem, 2002). 4. Darjah chaharum (fourth grade) These drugs are comparatively more potent and usually poisonous in action and could be fatal on their first dose. They are not used without amal-e-tadbeer (process of mitigation or purification). Affecting arwah-e-majari (vital force in the vessels), akhlat (humours) and rutoobat-e-saniyah, their effect reaches all organs of the body (Hakeem, 2002). Each of the above grades of Mizaj-e-advia is further subdivided into three sub-grades each. For example, a drug would be hot or cold in the awwal (initial), wast (middle) or akhir (end) sub-grades of the first grade (Hakeem, 2002). Determination of Mizaj and Its Grades The four qualities, i.e. hararat (heat), buroodat (cold), yaboosat (dryness) and rutoobat (moisture/wetness) are 74

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assigned to the drugs because of their actions in the normal body. The har (hot) drugs interact with the hararat-eghareezi (innate heat) in the body and produce heat, while barid (cold) drugs suppress the heat. The yabis (dry) drugs produce dryness or suppress the fluid secretions, while the ratab (wet) drugs increase fluidity/moisture in the body and remove dryness. However, a drug that enters a body of normal constitution and interacts or get affected by hararat-e-ghareezi but neither create any change in the real constitution nor disturb the function of arwah (vital force) and quwa (faculties) is called as Mo’tadil (normal) drug. To determine the grade of Mizaj, a drug should be given once in its therapeutic dose and should not be administered repeatedly. The drug should also be tested in a moderate season and on a normal healthy human body. Mizaj of Compound Formulae According to Unani scholars, the Mizaj of a compound formulation is the sum total of the temperaments of all single constituents (Ahmad, 1980). The British writer Campbell (1926) quotes the method of Al-Kindi (d. 873 C.E.) regarding the determination of Mizaj of a compound formula (Table 1), which is described here. In this method Al-Kindi has calculated the final Mizaj of formula as dry to the first grade. As in the sum the warm and cold are neutralized with each other; the moist 3 is then deducted from the dry 6 that gives final value as dry 3 that is further divided by the number of drugs (4), that gives a figure of 0.75 that may be considered as one (1) and that is finally Dry1. Table 1 Determination of Mizaj of a Compound Formula Cardamom Sugar Indigo Embelica Sum

Warm 1 Warm 2 Warm 1/ 2 Warm 1 Warm 41/2

Cold1/2 Cold1 Cold1 Cold2 Cold 41/2

Moist1/ 2 Moist1 Moist1/ 2 Moist1 Moist 3

Dry1 Dry2 Dry1 Dry2 Dry 6

Concepts Requiring Attention It has been observed that the temperament mentioned against a sufficient number of drugs are far from being correct and the temperaments of those drugs which are believed to be correct have never been confirmed in the laboratories. It could have been a matter of priority for the post graduate research departments in Ilmul-Adviyah (pharmacology) and the councils of research to take this aspect in their research programs and establish the temperaments of various drugs on the basis of scientific parameters. But unfortunately, as yet there are no established scientific guidelines for undertaking research study in this matter. The modalities are to be fixed by the teachers and research guides themselves which is rather an up hill task. Therefore they chose to establish the temperaments of drugs through philosophical deductions which have much more extensibility to befool any one (Ahmad, 1980). The above ideas are of a teacher of Unani system of medicine, that he has proposed twenty seven years back. But it is a sad matter that no one from the Unani fraternity has attempted to even think in this direction. How the system could progress until the basic concepts are lying remained untouched and frozen. The dose of any drug should be determined according to both: its therapeutic effects and Mizaj but it appears that the Unani scholars have not taken care of both aspects in fixing the grades of Mizaj. It is frequently observed that the drugs belonging to the same Mizaj and grade are being recommended in different doses. A thorough study reveals that the allocation of Mizaj and its relation with the dose and effect of the drug have appeared differently in the standard Unani texts and there is lot of confusion in this regard. Some limited examples are discussed in this paper just to bring the attention of the present system of Unani medicine to find suitable solutions for the same. If we take example of Mo’tadil drugs, it is considered that these drugs do not produce any significant effect on a normal body, then how can they be called as drug? How can they produce any effect in the patients? And by 75

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which parameter can it be proved that any drug is Mo’tadil? The doses of different Mo’tadil drugs are also different (Table 2), though they should be equal, considering that the drugs of same temperament could have similar effects. The drug is defined as “a medicinal substance used in the treatment of disease”. It may also be defined as a substance which acts by its Kaifiyat (quality). The Mo’tadil drug has no Kaifiyat then how it can produce any effect? The variation in the doses of Mo’tadil drugs goes up to 250 to 300 times higher doses in comparison to other drugs of the same temperament, e.g. the dose of Marwareed (pearl) is 30-60 mg, while the dose of Bihi Sheerin (Cydonia oblonga) is 10-50 gm (Kabiruddin, 1937). Such variations pre-required to be addressed. TABLE 2

Doses of the Drugs Possessing Different Mizaj (Temperament) S.No.

Name

Scientific name

Temperament

Dose

01.

Bihi Sheerin

Cydonia oblonga

Normal

10-50 gm

02.

Gudhal

Hibiscus rosa-sinensis

Normal

5-7 gm

03.

Shakr-e-teghal

Secretion of Teghal

Normal

1-2 gm

04.

Yaqoot

Red Ruby

Normal

125 mg

05.

Tila

Gold

Normal

30-60 mg

06.

Marwareed

Pearl

Normal

07.

Karela

Momordica charantia

08.

Asgandh

09.

30-60 mg

Hot Dry

3

10-20 gm

Withania somnifera

Hot Dry

3

3-5 gm

Suhaga

Borax

Hot3 Dry3

500 mg

10.

Azaraqi

Strychnos nux-vomica

Hot Dry

3

60-250 mg

11.

Miss

Copper

Hot Dry

3

15-30 mg

12.

Suranjan Talkh

Colchicum luteum

Hot Dry

3

125-375 mg

13.

Rai

Brassica nigra

Hot4 Dry4

1-3 gm

14.

Farfiyoon

Euphorbia antiquorum

Hot Dry

4

250-500 mg

15.

Heera Kasees

Ferrous sulphate

Hot Dry

4

60-250 mg

16.

Maghz Jamal Gota

Croton tiglium

Hot Dry

4

60-125 mg

17.

Beesh

Aconitum napellus

Hot4 Dry4

18.

Sammul-far

Arsenic

Hot Dry

19.

Tukhm-e-Imli

Seeds of Tamarindus indica

Cold Dry

20-40 gm

20.

Post-e-Turanj

Rind of Citrus medica

3

Cold Dry

3-5 gm

21.

Tabasheer

Bambusa arundinacea

Cold3 Dry3

1-2 gm

22.

Barg-e-Bhang

Leaves of Cannabis sativa

Cold Dry

1 gm

23.

Bazrul-banj

Hyoscyamus albus

Cold Dry

500 mg-1 gm

24.

Kafoor

Cinnamomum camphora

Cold Dry

125-375 mg

25.

Afiyoon-e-Kahoo

Lactuca sativa

Cold4 Dry4

20-40 gm

26.

Afiyoon

Papaver somniferum

Cold Dry

30-125 mg

27. 28.

Dhatura Almas

Datura alba Diamond

Cold Dry Cold4 Dry4

15-60 mg 15-30 mg

3 3

3 3 3

4 4 4

4

3 3

3 3 3

4 4

15-30 mg 1-5 mg

4 3

3 3 3

4 4

(Kabiruddin, 1937) 76

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Among the hot3 and dry3 grade drugs, the difference of doses goes even up to 600 to 700 times higher within the same grade of Mizaj, e.g. the dose of Kaf-e-Dariya (cuttle fish bone) and Mis (copper) is 15-30 mg, while the dose of Karela is 10-20 gm. The difference goes up to 150 to 300 times greater within the doses of the drugs having cold3 and dry3 grade temperament, e.g. the dose of Camphor (Cinnamomum camphora) is 125-375 mg, while the dose of Tukhm-e-Imli (seeds of Tamarindus indica) is 20-40 gm. Among the hot4 and dry4 grade drugs, the difference of doses goes even up to 600 to 1000 times higher within the same grade; e.g. the dose of Samm-ul-far (arsenic) is 1-5 mg, while the dose of Rai (Brassica nigra) is 1-3 gm. The difference is higher, i.e. 1300 to 1400 times, within the doses of drugs possessing cold4 and dry4 grade temperament, e.g. the dose of Afiyoon (opium – Papaver somniferum) is 30-125 mg while the dose of Afiyoon-e-Kahoo (Lettuce opium) is 20-40 gm. (Kabiruddin, 1937). It has been observed that the Mizaj of the same drugs is described differently by the authors of different texts. For example, Mohammad Husain in his Makhzan-ul-advia (Husain, 1771) described the Mizaj of Parsiyaoshan (Adiantum capillus-veneris) as normal inclined towards heat and dryness; while Najmul-Ghani quoted opinion of ancient Unani scholars regarding the Mizaj of the same drug in the following words – “According to Galen it is normal in heat and cold; according to Ibn Sina it is inclined towards heat with very less dryness; while in the opinion of Al-Razi it is hot and dry in the first grade. Some other scholars say that its heat reaches up to second grade” (NajmulGhani, 1926). The Mizaj of Khyar-shamber (Cassia fistula) is described as hot1 and moist1 grade by Mohammad Husain (Husain, 1771). He did not clarify the part of the plant to which the said Mizaj is assigned. According to Najmul-Ghani, the Mizaj of the pulp of Khyar-shamber is hot1 and moist1; he also says that according to some scholars it is hot2 and moist2 but in the opinion of Ibn Sina it is normal in heat and cold and moist. According to others it is cold1 and moist1 (Najmul-Ghani, 1926). It has also been observed that the Mizaj described are not in accordance with the therapeutic actions of the drugs, e.g. Asgand (Withania somnifera) is described as hot3 and dry3 and its action as musakkin-e-a’sab (nervine sedative) (Kabiruddin, 1937). Its name itself suggests its action and cold nature (somniferum = to induce sleep), then how it could be categorized in the hot drugs? It is one of the basic fundamentals of Unani medicine that the determination of Mizaj and its grades can only be assessed by the prescribed dose but there is no parameter for the determination of “First Prescribed Dose (F.P.D.)”. We are not sure, nor can we admit confidently that the dose of any given drug is very correct or appropriate. This type of difference in opinion of the scholars create lot of confusion amongst researchers and clinicians because any change in Mizaj would also change effects of the drug. Therefore standardization of the grades of Mizaj is essential for laying down a foundation for further experimentation or clinical research as per Unani concepts with regard to natural drugs. Suggestions and Proposals As there are many irregularities found in the grading of the Mizaj of Unani drugs, it therefore seems justified to mention that the determination of Mizaj and its grade should not depend upon the dose and kaifiyat of the drug but it should be decided on the basis of the pharmacological effects of the drug. The dose should be determined on the basis of the effects, Mizaj and grades. It is also considerable that the proportion of active ingredients in the crude drugs may be variable and thereby effects of the drugs could change with different doses of the same drug and hence the drug of any particular temperament could show variable effects at different doses. Then how could we determine the temperament on the basis of the dose of the drug? Hence once again it may be realized that fixing temperament on the basis of the active ingredients and their effects is justifiable and should be done involving proper parameters of relevant research methodology. There should be a clear-cut line of demarcation for each quality, Mizaj, grades and sub-grades in relation with doses, e.g. this drug is hot and dry in third grade, in its first sub-grade and it should be given in this (particular) dose range. The doses could be determined according to their natural sources i.e. plant, mineral and animal origin etc. For example, if an animal origin drug is hot3 and dry3 in its first sub-grade then the dose range shall be this much and if in the second sub-grade, the dose range shall be that much etc. On the contrary, if a mineral drug is hot3 and dry3 77

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in its first sub-grade, the dose range shall be this much, that may be similar or different from the prescribed range of the animal origin drugs. The terms like ‘Mo’tadil’ drugs should be excluded from literature. The doses should also be mentioned in relation to the body weight and their timings should be mentioned and followed in general practise. It is very interesting that Hakim Syed Ishtiaq Ahmed of Delhi had proposed that the temperament of drugs should be investigated by taking temperature and B. M. R. of the individuals using most sensitive instruments before and after administration of the drug. He suggested that the process should be repeated for a week or ten days. The proteinbound iodine (P.B.I.) should also be measured. He stated that the subjective feelings of the individuals should be carefully noted and signs should be carefully observed. The symptoms pertaining to the sympathetic and parasympathetic nervous system should also be observed. A thorough examination of Mizaj should be carried out by the assessment of Ajnas-e-‘ashrah (ten principles). Then the signs and symptoms should be correlated with the signs and symptoms fixed for each quality. The subjects included in the study should be Mu’tadil (equable or normal) in temperament and healthy, otherwise the chances of error would be increased. He also suggested that the experiments for Mizaj of the drugs those are in clinical use since thousands of years should not be conducted on laboratory animals. Because there is a vast difference in human and animal temperament and their results can never be relied upon. However the animals can be chosen to gain the first hand knowledge pertaining to a new drug which has not yet been used on human subjects for clinical purposes (Ahmad, 1980). There should be a concrete guideline and parameters for grading Mizaj and doses and the old system should be reviewed and made error free. It is possible through repeated reviews and meetings of the subject experts, under provision of any research project undertaken by any government approved institution of Unani System of Medicine. The post graduate institutions as well the Central Council for Research in Unani Medicine should be involved in this research task to modify and correct the irregularities happening since long time and establish the evidence-based Unani system of medicine that would be acceptable to the global community.

REFERENCES

1. 2. 3. 4. 5. 6.

Hakeem, M.A. (2002). Bustan-ul-Mufradat, Idarah Kitab-ush-Shifa, New Delhi, India, p. 57. Husain, Mohammad (1771). Makhzan-ul-Advia, Matba Munshi Nawal Kishore, Lucknow, India, pp. 9-12, 163, 329. Ibn Sina, Abu Ali (1930). Kulliyat Qanoon, Daftar al-Masih, Delhi, India, pp. 304-306. Kabiruddin, Mohammad, (1924). Ilmul Advia Nafeesi, Idarah Matbu’at Sulaimani, Lahore, Pakistan, p. 2. Kabiruddin, Mohammad, (1937). Makhzan-ul-Mufradat, Shaukat Book Depot, Gujarat, Pakistan. Najmul-Ghani, (1926). Khazainatul-Advia, Matba Munshi Nawal Kishore, Lucknow, India, p. 1361.

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